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Marina CHRISTENSEN
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Clin Sci (Lond) (2005) 108 (2): 113-119.
Published: 21 January 2005
Abstract
ANG II (angiotensin II) facilitates catecholamine release from the adrenal medulla and neuronal NE (noradrenaline) release. Since animal experiments point to specific sympatho-inhibitory properties of the AT 1 (ANG II type 1)-receptor blocker EPRO (eprosartan), the primary aim of this study was to clarify if EPRO inhibits sympathetic reactivity in humans as determined by the effect of EPRO on insulin-induced catecholamine release. Sixteen healthy male volunteers were randomized in a double-blind cross-over study to receive a single dose of EPRO (600 mg) compared with placebo, followed by insulin-induced hypoglycaemia [0.15 IU (international unit)/kg of body weight; intravenous bolus] on two study days 1 week apart. From baseline to the end of hypoglycaemia (170 min), the sympatho-adrenal reactivity was mapped by invasive continuous blood pressure monitoring and repeated measurements of FBF (forearm blood flow), arterial and venous concentrations of glucose, catecholamines [EPI (adrenaline) and NE (noradrenaline)], renin, ANG II and aldosterone. EPRO induced an 8–10-fold increase in plasma renin and ANG II concentrations compared with placebo. Plasma glucose decreased equally during placebo and EPRO from baseline 5.9 mmol/l to 1.9 mmol/l and 2.1 mmol/l respectively, inducing a 17-fold increase in arterial EPI concentration at peak. The AUC (area under the curve) during hypoglycaemia for arterial EPI concentrations was 314±48 nmol·min·l −1 in placebo compared with 254±26 nmol·min·l −1 following EPRO treatment ( P =0.14). EPRO attenuated the corresponding AUC for the EPI-induced pulse pressure response (4670±219 mmHg·min in EPRO compared with 5004±266 mmHg·min in placebo; P =0.02). Moreover, EPRO caused a less pronounced increase in FBF compared with placebo (402±30 compared with 479±46 ml·100 g −1 of body weight; P =0.04). Musculocutaneous NE release was not affected by EPRO and the AUC for NE release was 51.69±15.5 pmol·min −1 ·100 g −1 of body weight in placebo compared with 39.35±18.2 pmol·min −1 ·100 g −1 of body weight after EPRO treatment ( P =0.57). In conclusion, EPRO did not significantly inhibit sympathetic reactivity compared with placebo; however, it blunted the haemodynamic responses elicited by the sympatho-adrenal stimulation which only tended to be attenuated by this drug.